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Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: a mechanistic

Guus A de Waard1,2, Christopher J Broyd2, Christopher M Cook2

  • 1Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.

Open Heart
|April 19, 2019
PubMed

Insights

Diastolic-systolic velocity ratio (DSVR) decreases with coronary stenoses because increased stenosis resistance impacts total vascular resistance more during diastole than systole. This finding clarifies DSVR

Area of Science:

  • Cardiovascular physiology
  • Coronary artery disease
  • Hemodynamics

Background:

  • Diastolic-systolic velocity ratio (DSVR) is a resting index used to assess left anterior descending artery (LAD) stenoses.
  • DSVR can be measured non-invasively via echocardiography or invasively using intracoronary Doppler flow velocity.

Purpose of the Study:

  • To elucidate the fundamental rationale behind the decrease in DSVR observed in coronary stenoses.
  • To investigate the relationship between stenosis severity, vascular resistance, and DSVR.

Main Methods:

  • A cohort study involving 228 stable patients with simultaneous intracoronary Doppler flow velocity and pressure measurements in the LAD.
  • Assessment of phasic stenosis resistance, microvascular resistance, and total vascular resistance at rest.
  • Classification of stenoses severity based on fractional flow reserve (FFR) strata.

Main Results:

  • DSVR was reduced in stenoses with lower FFR values.
  • Microvascular resistance was higher during systole than diastole.
  • Stenosis resistance constituted a larger proportion of total vascular resistance during both systole and diastole in lower FFR strata, with a greater impact during diastole.
  • A strong inverse correlation was found between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001).
  • Invasive and non-invasive DSVR measurements showed good correlation (r=0.82, p<0.001).

Conclusions:

  • The decrease in DSVR distal to coronary stenoses is attributed to the greater influence of increased stenosis resistance on total vascular resistance during diastole compared to systole.
  • This finding provides a mechanistic explanation for the utility of DSVR as a diagnostic index for coronary stenosis.
Abstract

Keywords:
echocardiographymicrovascularstable angina

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